PRESCRIPTION FOR SECRECY
Is your doctor banned from practicing in other states? State licensing systems keep patients in the dark
Like traveling medicine hucksters of old, doctors who run into trouble today can hopscotch from state to state, staying ahead of regulators.
Instead of snake oil, some peddle opioids. Others have sex with patients, bungle surgeries, misdiagnose conditions or are implicated in patient deaths. Even after being caught in one state, they can practice free and clear in another; many hold a fistful of medical licenses.
An investigation by the Milwaukee Journal Sentinel and MedPage Today found at least 500 physicians who had been publicly disciplined, chastised or barred from practicing by one state medical board were allowed to practice elsewhere, often with a clean license.
Look up Jay Riseman on the website of the Division of Professional Registration in Missouri, where he practices as a hospice doctor: It lists no disciplinary history, no red flags.
In Illinois, the families of three patients who died remain haunted by what they say he did.
Among the doctors identified by the Journal Sentinel and MedPage Today, the single biggest reason for board action was medical errors or oversights. One fifth of the cases were a result of
putting patients in harm’s way.
All slipped through a system that makes it difficult for patients, employers and even regulators in other states to find out about their troubling pasts.
The list represents a fraction of the nation’s roughly 200,000 physicians who hold licenses in more than one state but probably far underestimates the scope of the problem. Most medical errors are never noticed, much less reported, said Julia Hallisy, founder of the Empowered Patient Coalition, a California-based patient advocacy group.
“The numbers you’re showing are not anywhere near the real numbers,” she said. “If something goes wrong in a surgery, or you get an infection, or your 80year-old mother is given the wrong medicine, you may never know that came from this doctor, their impairment, their lack of skill.
“People who want to make the case that we have bigger fish to fry: This is bigger than we know.”
A 30-year-old federal database, the National Practitioner Data Bank, was supposed to keep state medical boards and hospitals apprised of doctor transgressions around the country.
It has never been available to the public, provides only portions of troubled medical backgrounds and even state medical boards rarely turn to it.
Families’ grief
Gayle Simpson Bowman remembers the days when her young son and daughter were doted on by their grandmother, Frances Simpson. Simpson was like a third parent. She got the children ready for school each morning and spent summer days playing with them.
In 1998, Simpson, 68, underwent elective colon surgery. Riseman was to oversee her recovery.
According to the family’s lawsuit, he failed to remove and relocate a catheter after tests showed signs that a staph infection had spread to her blood. He further failed to act when she showed symptoms of sepsis, including severe vomiting and fever, the suit says. Simpson died a few days later. “My mom was a great woman who died a painful and avoidable death,” Bowman said. “The hardest part is to know that he still is practicing medicine. I don’t know how that can happen in this world.”
In 1999, Riseman prescribed a laxative for 2-month-old Morgan Brooks, according to her family’s lawsuit. The dose was more than twice what is allowed for an adult and about 10 times what should be given to a child 5 to 9 years old.
The baby girl died.
“It’s something you don’t ever get over,” said her mother Tonya Brooks, who lives in Decatur, Ill.
The families of Morgan Brooks and Simpson said they reached confidential settlements with Riseman.
In April 2002, the Illinois Board of Medicine put Riseman on indefinite probation, allowing him to perform surgery only after consulting with an approved surgeon. The order was based on the cases involving the baby and other allegations of malpractice. The board lifted his indefinite probation in 2007.
He obtained a license in Missouri in 2008 and practices there today.
In May 2009, Colorado denied Riseman’s attempt to get licensed in the state. Nearby Kansas issued him a license later that year.
The Kansas Board of Healing Arts noted his problems in Illinois and prohibited him from performing surgery of any kind. In 2011, it lifted that restriction. Riseman declined to be interviewed or respond to questions for this article.
Laurel Gifford, a spokeswoman for St. Luke’s Hospital in Kansas City, where he works, said Riseman can be proud of his career. “From his perspective, he had a hard time, and he’s moved on,” she said.
She released a statement that said: “During the past eight years Dr. Riseman has served his patients, their families and his staff with clinical excellence, patience, and insight. His commitment to the field of hospice and palliative care has enriched the lives of many he has touched with his thoughtful care and attention.”
Lack of data, transparency
Lacking publicly available data, the Journal Sentinel and MedPage Today worked with TruthMD, a private company that compiles doctor dossiers drawn from thousands of sources — including civil and criminal courts, state medical boards and the Food and Drug Administration. The data go back 15 years and include about 1 million doctors.
The company provided an initial summary of doctors who had been in trouble in one state since 2011 but held clean licenses elsewhere.
Reporters verified the cases, investigated individual examples and obtained thousands of pages of documents from criminal and civil courts around the country, as well as state medical boards, the FDA and other sources.
A paper in 2016 in The New England Journal of Medicine found that 1% of doctors were responsible for 32% of paid malpractice claims. Doctors who had licenses in multiple states before being rebuked accounted for most of those practicing freely in one state after being disciplined in another. In about 20% of the cases, doctors sought new licenses after getting in trouble.
“It’s a highly flawed system,” said Robert Wachter, chairman of medicine at the University of California-San Francisco School of Medicine. “It has created a patchwork of accountability. It takes something pretty bad to get in trouble with your state licensing board.”
Wide variation among states
The Journal Sentinel and MedPage Today surveyed 62 boards across the country that regulate physicians at the state level. Governors appoint some or all members of 56 boards.
Each board can have wildly different rules. A study in 2016 in the British Medical Journal found annual average rates of discipline ranged from 1.9 actions per 1,000 doctors in Massachusetts to 10.3 in Delaware. There are huge differences in the amount of information each board makes available about doctors to the public.
When it comes to problems, there are many sources of information, but each covers only a portion of a doctor’s background: discipline by a medical board; discipline from other states; malpractice claims and payouts; loss of hospital privileges; criminal convictions; Medicaid/Medicare exclusions and fraud charges; and actions by the federal regulators, such as the FDA or the Drug Enforcement Agency. No state’s website consistently reports all of the pieces.
“Should all state medical boards list all of these elements? Absolutely,” said Sidney Wolfe, a physician and director of the patient advocacy group Public Citizen. “A background check on a doctor you have, or one you’re thinking of going to, may have more of an effect on your health than anything else.”
John Fauber is a reporter for the Milwaukee Journal Sentinel. Matt Wynn and Kristina Fiore are reporters with MedPage Today.